For more than six years, Kim Kluger-Bell tried to have a second child. After six in vitro fertilization failures and two ectopic pregnancies that ruptured her fallopian tubes, she gave up. But the grief she was feeling wouldn't go away. She combed bookstores for resources to help her cope, but found none. She took this to mean that her grief was abnormal, that pregnancy losses must be minor events, that grieving them bordered on the pathological.
In fact, pregnancy losses are not uncommon. According to a 1996 U.S. Census Bureau study, every year, 20 percent of all pregnancies end in miscarriage, and 25 percent end in abortion. That's a lot of potential grief.
Kluger-Bell was determined to write the book she hadn't been able to find so other women wouldn't find themselves in the same quandary. A psychotherapist, she spent a year interviewing patients, colleagues and friends who had experienced pregnancy loss of all kinds -- from ectopic pregnancies and failed in vitro fertilization attempts to miscarriages, stillbirths and abortions. Her new book, "Unspeakable Losses," pierces the silence surrounding the emotional fallout from pregnancy loss and abortion. Kluger-Bell spoke with Salon in her office in Berkeley, Calif.
Why do people tend to gloss over pregnancy losses?
Pregnancy loss, by its nature, is very intangible. It's not the loss of a known person. That makes it more difficult to define and therefore talk about. We also have so much controversy right now around abortion, and there's a real reluctance to talk about the grief that can accompany abortion.
Is there a difference in how a person grieves if they've had an abortion or miscarriage?
There is a difference. In abortion, the loss is chosen, and that often adds an extra layer of guilt for people to emotionally resolve. But I haven't seen any difference in the intensity of the grieving between the two. Especially in the case of genetic abortion or multi-fetal reduction, where people choose to abort a wanted child. People are often very torn about the decision.
In your book, you encourage people to make their losses more
It's a critical part of beginning the grieving process. I like to ask my clients to recall the fantasies they had about this particular baby. For example, did they think they were going to have a boy or a girl, and what did they think life was going to be like with this particular child?
But it's often painful and difficult for people to remember these
things. And often people don't want to remember. But once they are able to get in touch with that, they are likely to be very relieved afterward. People need reassurance that it's possible to get through grief. That there's an end to it.
How do people begin to grieve?
The first step is to become conscious of the fantasy you had about the child you lost. I also recommend, especially in the case of early losses, that people make something to focus on, like the Jizo figure in Japanese culture.
Which is what?
The Jizo is a Japanese Buddhist deity -- a guardian of children from this world to the next. In the past, Jizos were used only for children who died shortly after birth and those who had been miscarried. But since World War II, the Japanese have had a huge increase in abortions and they have adapted this old tradition to accommodate their new needs.
Parents set up little Jizo statues in their homes or temples and visit them on a regular basis. They bring gifts and toys. People often visit with their other children. It's a much more conscious way of dealing with all this than how we do it in our country.
I imagine many Americans would find these figures morbid -- they might think that dwelling on a lost pregnancy might only make things worse.
I'm not surprised when people say, "Isn't talking about it just going to make it worse? Dwelling on it is going to make me feel bad. Shouldn't I just get over it and get on with my life?" I agree that dwelling on losses interminably is pathological. But it's crucial to process our grief before we can let it go. Otherwise, it starts to affect you in ways that are not very clear, like becoming depressed. The whole emphasis to move on and lead your day-to-day life is such a strong impulse for Americans.
Do women who choose abortion receive even less support than those who miscarry?
Of all the people silenced around pregnancy loss, those who have had abortions have the least support in our culture. They have even more hesitancy to speak out about their experiences.
Is this because of the strength of the anti-abortion movement?
Yes. There is a strong reluctance to talk about any negative emotional fallout from abortion.
Because people fear that speaking out could be used rhetorically by the anti-abortion movement?
Yes -- it certainly could be and is. When I was writing the book, it was almost impossible to find any data on the psychological impact of abortion, except data used as propaganda by the anti-abortion movement, which is highly inflammatory.
Then it's understandable that people who are pro-choice would not want to open that door. So why do you think they should?
Because there are a lot of people who are not getting the help they need precisely because of that fear. They need a place to be able to talk about their experiences too. I don't think anyone approaches abortion lightly. There is a big myth within the pro-life movement that women have abortions callously, flippantly, without any second thoughts.
But there probably are those for whom having an abortion is not a big deal.
Yes, and this is where the issue gets tricky. There's a huge range of experiences. There are people who have miscarriages and are happy about it. They don't want to be pregnant, and it's not a major loss. For another person it can be devastating.
- - - - - - - - - - - - - - - - - - - - -
So what does the range of reactions depend on?
Who the person is. What life circumstances they are in at the time. The unconscious fantasies that they've had about the child they lost. And our relationship with our own parents. A lot of our feelings about becoming parents depends on that.
Do you find there is a difference in the severity of grief between an early miscarriage and a later one? Or between a miscarriage and a stillbirth?
The traumatic power of a particular loss, whether it's early or later, depends on what kind of hopes and dreams were invested in the child, and how long the child was wanted.
In my practice and in my own experience, I find that people assume that the shorter the pregnancy, the less psychologically traumatic they were. And I haven't found that to be the case.
In the case of stillbirth, you encourage parents to see and touch the baby. Why?
There has been a trend in the last 15 years to do that. There's an organization in England call SAND -- Support After Neonatal Death. One of the things they recommend is that parents see, touch and take pictures of the baby in order to facilitate the grieving process. Most people that I've spoken to were afraid to see their baby, but afterward were really glad they had. It helped them move from a half-dazed state of belief that their child was still alive to realizing it was not. And it often is a way of honoring a lost child and saying goodbye with dignity and love. It prevents people from later feeling they let the child go without really saying goodbye.
You mention that rituals can help the grieving process. Can you give an example?
It can be something as simple as lighting a candle with your partner on an anniversary of a due date or loss. Or asking your rabbi or priest to acknowledge them during a service. It's a way of expressing caring. And that's what gets put aside when you can't talk about a loss. The person is filled with longing with no place to express it. Ceremonies can give you a sense that you are carrying out an important tribute. So there's a sense of completion, of fulfillment.
That must be especially helpful for people who have miscarried and feel they failed to protect their unborn child.
Absolutely. When traumatic things happen, we assign an unconscious meaning to them. One of my patients who had a miscarriage felt terribly inadequate. The primary parental responsibility is to take care of your child, and she felt she had failed.
Why did you include a whole chapter devoted to the impact of
pregnancy loss on men?
I've been in contact with a lot of men who have been profoundly affected by pregnancy loss. They haven't been given their fair share of time to be heard on this topic and that is unfortunate. I've had men in my practice talk about abortions that their partners have had, and that they've been haunted by for years.
Is a man's grief different from a woman's?
There are certain cultural expectations that make it more difficult for men. They are not expected to openly cry or show strong emotions except anger. They get put into this role of needing to be the caretaker for women. Men are often left out of the grieving process.
What can friends and family do to help a person mourn a loss?
Stay available and listen. It's not easy, but you don't have to do very much but be there. You don't have to fix it. Just sitting with someone while they're crying is more healing than anything you could possibly say or do. That's enough.